Pelvic floor and PGP

What is the pelvic floor?

The pelvic floor is a group of muscles which attaches at the front to your symphysis pubis and at the back to your sacrum. It acts like a hammock, holding all your pelvic organs, and keeps you continent of urine and faeces.

When do pelvic floor problems start?

Pelvic floor problems can start if the pelvic floor muscles, often on only one side, are too tight or ‘overactive’ (sometimes referred to as ‘muscle spasm’). This can be due to holding your pelvic floor muscles too tightly, which can happen when this group of muscles is compensating for other joints and muscles in the pelvis that are working incorrectly (like in PGP). This overactivity can also be linked to previous pelvic floor trauma, for example, after a tear, forceps delivery or episiotomy during birth.

Symptoms:

Pelvic Girdle Pain (PGP) which is not getting completely better with manual therapy, or which keeps coming back even after good treatment.

A bulge in the vagina or a feeling of pressure in the vagina or rectum.

Women can assume that if they have these symptoms the pelvic floor is weak, which is often not the case. However, as with any muscle, the pelvic floor muscles are likely to weaken the longer they are functioning incorrectly (the longer that they are in spasm) so addressing the cause of this is important.

What can I do about it?

As with PGP, pelvic floor problems often respond well to manual therapy treatment. The treatment for pelvic floor overactivity is physiotherapy which is done by internal examination through the vagina, finding tight ‘trigger points’ and releasing them using pressure from the therapist’s fingers. This is usually followed by exercises to retrain your pelvic floor muscles to get them working normally and avoid them tightening up again.

The therapist will teach you to contract and relax the pelvic floor muscles, rather than just focussing on contraction which women can easily do if they are not taught to do these exercises correctly. Doing these exercises incorrectly is likely to increase pelvic floor tightness and pain. The therapist may use a biofeedback machine to show you how to do these exercises correctly if you are finding them difficult. However, biofeedback treatment alone is unlikely to address the muscle overactivity. Other exercises may include self-trigger point release and specific stretches or strengthening exercises of other muscles which can be affected by pelvic floor dysfunction (and PGP) such as abdominals, gluteals etc. Your therapist is also likely to discuss lifestyle changes to complement treatment including bladder and/or bowel re-training, relieving constipation, minimising heavy lifting and reducing weight, depending on your situation.

As with all manual therapy treatments, this treatment can be uncomfortable at the time, but the pain should get better soon after treatment. You should walk out feeling better after each treatment, and should see continued improvement between treatments as well.

During treatment for the pelvic floor, or soon after, you will need to have your pelvic joints checked by your manual therapist to ensure your joints are also functioning normally. Please see our ‘Treatment’ section for PGP for more information.

Who can provide this pelvic floor treatment?

This treatment can be carried out by a physiotherapist specialising in myofascial release and trigger point therapy for the pelvic floor, usually a women’s or pelvic health physiotherapist. Your pelvic joints may be checked and treated by the same therapist at the same time, or you may need to see a specialist manual therapist separately, depending on the experience of the therapist you are seeing.

It is possible to be referred on the NHS for women’s or pelvic health physiotherapy but it is important to be aware that not all women’s health physiotherapists use this trigger point release treatment approach, so some women with pelvic floor overactivity choose to find a private women’s health physiotherapist offering this treatment. Unfortunately, you would need to pay for any private treatment.

I have tried this treatment but I am still experiencing pain, what should I do next?

As with treatment for PGP, it can be difficult to find the right practitioner on the NHS or privately. The same applies to this treatment as to the manual therapy treatment of pelvic joints; if you are not feeling relief in pain and/or function (preferably both) after each treatment then it may be worth trying another practitioner.

Further information:

More information about pelvic floor dysfunction and treatment is available at www.pelvicphysiotherapy.com, which also includes a list of practitioners who have undertaken extra training in this type of treatment.

If you feel you have responded to a course of pelvic floor treatment but you still have pain and problems significantly affecting your day-to-day life, you may find the information in our ‘PGP Following Pregnancy’ section helpful.

The Pelvic Partnership consists of volunteers who have had Pelvic Girdle Pain (PGP) and wish to support other women. We aim to pass on information based on both research and the experience of other women with PGP. We are not medical professionals and cannot offer medical advice and the information we provide should not take the place of advice and guidance from your own health-care providers. Material on this site is provided for information and support purposes only.